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Toothpaste Tips and Myths

by Berkeley Wellness  

It used to be simple to pick a toothpaste: Perhaps you chose a familiar brand and a favorite flavor and just made sure it had fluoride. Today, the choices—and claims—seem endless. Colgate alone sells more than three dozen different kinds. Here we decipher the terms on the labels—from fighting cavities to whitening your smile—that sometimes deliver but also often overpromise. Note that some ingredients play more than one role in tooth care. For definitions of terms such as plaque and tartar, see Glossary of Dental Terms.

Anti-cavity: This claim is pretty cut and dried—and trustworthy. If toothpaste contains fluoride, it helps prevent cavities by several mechanisms, including remineralizing tooth enamel so it can be more resistant to the acid produced by decay-causing bacteria. Toothpastes with higher fluoride concentration are also available by prescription from your dentist, if needed.

Fights plaque and gingivitis: Ingredients such as stannous fluoride and sodium bicarbonate (baking soda) can help reduce plaque, giving these claims some merit. Triclosan, an antimicrobial agent in Colgate Total, has been found to be particularly effective, but it has also been linked to hormonal changes in animals and may be contributing to the development of antibiotic resistance. According to the American Dental Association, at least part of the anti-plaque effect comes simply from the mechanical action of brushing and the cleaning power of toothpastes that contain mild abrasives (such as calcium carbonate, silicates, and phosphate salts).

Tartar control: Toothpastes with pyrophosphates or zinc citrate, among other ingredients, can help reduce the buildup of tartar (hardened plaque), but only on the tooth surface not covered by the gums. And it’s below the gum line where tartar poses the biggest risk for periodontal disease. Moreover, if you already have tartar buildup, no toothpaste will remove it.

Restores enamel: Basically any toothpaste that has fluoride can make this claim, since fluoride helps remineralize tooth enamel. Some products may also contain a calcium phosphate compound, which has been found in lab research to improve mineralization and reduce erosion. An informal investigation by the Wall Street Journal several years ago noted that toothpastes making an enamel claim were almost identical in ingredients—short of extra fluoride—to ones not making the claim. Keep in mind also that while some toothpastes can make tooth enamel more resistant to acid, none actually “strengthen” the enamel, as often claimed, in terms of mechanical stress.

Whitens teeth: “Whitening” toothpastes generally contain more abrasives than regular toothpastes, which can reduce surface stains, at best. They may be of some benefit if you have a light stain—say, from coffee—on your teeth, but they won’t actually whiten your teeth and, depending on the degree of abrasiveness, they can wear down the enamel and cause dental sensitivity if overused. Other surface whitening ingredients are sodium hexametaphosphate, which disrupts the protein film on the tooth surface that’s stained so that it can be removed with brushing, and sodium pyrophosphate, which absorbs the stain molecules. Some toothpastes also have peroxide, a bleaching agent that breaks down stains—but given the low concentration and short exposure time, it’s questionable how effective they are at whitening below the surface of the tooth.

Freshens breath: Flavoring agents such as peppermint, cinnamon, and menthol can mask odors temporarily. But the brushing action is also important, since it removes food debris and plaque that contribute to bad breath—as are regular flossing and tongue scraping. If you have chronic bad breath, consult your dentist.

Natural: Though “natural” generally means free of added color, artificial flavors, or other synthetic chemicals, the term is not regulated in consumer products. And some toothpastes that make the claim, like Tom’s of Maine, contain sodium lauryl sulfate, glycerin, and other processed ingredients. In 2014 the company Hello Product was forced to remove package claims that its flavored toothpastes were “99% natural,” since they contain sodium lauryl sulfate and sorbitol.

Reduces dental sensitivity: Many toothpastes make this claim, but do they deliver? See Help for Sensitive Teeth.

Bottom line: A basic toothpaste that contains fluoride (and a mild abrasive) is all that most people really need, combined with good mechanical scrubbing action. The ADA Seal of Acceptance from the American Dental Association ensures that the toothpaste meets the organization’s standards for safety and effectiveness for the therapeutic claims being made. Still, because some people may benefit from some extra ingredients, you should talk to your dentist or a pharmacist about which product is best for you.

Navigating the toothpaste aisle

  • Avoid toothpastes with triclosan. This ingredient is not necessary, and we don’t think its benefits outweigh its potential risks (see above) for most people.
  • While tartar-control toothpastes can help protect against tartar buildup, the gold standard for removing it once it has hardened on teeth is to physically scrape it away at regular dental cleanings; your dentist may also recommend that you use a rubber-tipped gum stimulator, water flosser, or other tool between cleanings to help remove tartar on your own.
  • The most effective way to whiten your teeth is to have them professionally bleached at the dentist’s office or with a prescribed formula at home. Over-the-counter whitening tray kits and strips are not as strong as dentist products, but they are more effective than whitening toothpastes. To learn more, see The Truth About Teeth Whitening.
  • If you’re prone to canker sores, try a toothpaste without sodium lauryl sulfate (a detergent that helps loosen plaque and debris). Though the evidence is not conclusive, some studies have linked this ingredient with these mouth sores. Flavoring agents and preservatives in toothpaste may also be irritating for some people, as may pyrophosphates in some tartar control products and peroxide in some whitening ones.
  • Be aware that “natural” toothpastes don’t always contain fluoride.
  • The American Dental Association recommends toothpastes with an abrasive index under 100 to avoid wearing down enamel. For ratings of common toothpastes, see this chart.